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Five Things to Know About Dialectical Behavior Therapy

Young boy attending a DBT therapy sessionAt Alpine Recovery Lodge, we tailor our addiction recovery programs to each patient’s needs.

We understand that the causes that contribute to addiction are as individual as our patients. The notion that a cookie-cutter approach could work is unacceptable to us. In fact, we think that it’s a dangerous thing to do and increases the chances of patients having a relapse.

We use many different forms of therapy and treatment to help our patients overcome addiction. Our treatments combine individual therapy, family therapy, and group therapy with other tools to help patients regain a sense of independence and control.

One form of therapy that we have found to be particularly helpful in the treatment of addiction is dialectic behavior therapy, or DBT.

You may be unfamiliar with DBT, but here are five things you need to know about it and how it relates to addiction.

#1: Dialectical Behavior Therapy Works on the Patient’s Reactions to Difficult Situations

The first thing you need to know about dialectical behavior therapy is that its primary goal is to help patients, including those with addiction issues, learn how to control negative thoughts, feelings, and reactions.

Some people just seem to have an easier time controlling their emotions than others. DBT was first developed as a method of treating people who had Borderline Personality Disorder (BPT).

BPT is a serious disorder, and certainly not all addicts have BPT. However, many of the behaviors and issues that arise in people who struggle with addiction are similar to those that show up in people with Borderline Personality Disorder.

People who have BPT sometimes engage in self-harming behavior including cutting and suicidal ideation. It is possible to look at drug and alcohol abuse as a form of self-harming behavior, albeit less obviously dangerous than cutting.

The goal of DBT, then, is to help patients learn to recognize and control their reactions to negative emotions and situations. Through a combination of talking and role-playing, addicts can learn to reign in extreme reactions and find positive ways to cope with their feelings.

As patients gain control, they are less likely to relapse and turn to drugs or alcohol as a means of processing negative emotions. The new, learned behaviors take the place of their old, destructive behaviors.

#2: Dialectical Behavior Therapy Uses a Combination of Group and Individual Therapy

Some forms of therapy are specifically carried out in a one-on-one therapeutic relationship between the therapist and the patient. Others focus on therapeutic care in a group setting.

Dialectical Behavior Therapy uses both individual and group therapy to help patients gain control over their emotions and harmful behaviors.

  1. Individual therapy sessions tend to focus on problem-solving techniques. Patients look at issues that arose since their last therapy session and talk about coping mechanisms and what they can do to deal with similar situations in the future. They may also talk about how to improve self-esteem and reduce post-traumatic stress to improve their quality of life.
  2. Group therapy sessions tend to last several hours, and they focus on four distinct areas of care:
    1. Interpersonal effectiveness
    2. Stress tolerance and acceptance of reality
    3. Regulation of emotions
    4. Mindfulness skills

Both the individual and the group sessions of dialectical behavior therapy are geared toward helping the patients solve problems and learn how to cope with what may be recognized as extreme emotional reactions.

To reap the benefits of DBT, patients must commit to attending both individual and group therapy sessions and to working through the exercises and challenges presented.

Dialectical behavior therapy requires a significant time commitment on the part of the patient. That may mean that the patient’s loved ones have to accommodate their schedule to make time for therapy. A good recovery program requires a commitment from both the patient and their support circle.

#3: Dialectical Behavior Therapy Has Its Roots in Buddhism

Therapy is not a religious practice, so it might surprise you to learn that dialectical behavior therapy has its roots in Zen Buddhism.

At the heart of Buddhism is a recognition of one’s own place in the world. The practices of mindfulness and meditation help hone our ability to do all of the following:

  • Learn to practice emotional detachment that allows us to view our emotions as emotions but in a dispassionate way.
  • Understand how emotions, particularly negative ones, affect our brains and thus, our behavior.
  • Compartmentalize negative emotions in a way that is both mindful and healthy.
  • Form healthy emotional boundaries by practicing detachment both with our own emotions and those of other people.
  • Become comfortable with our thoughts and emotions without being ruled by them.

Mindfulness practices include mindful breathing, mindful walking, and meditation. Meditation itself takes many different forms, but mindfulness meditation is one of the simplest forms of meditation.

People who meditate on a regular basis tend to have better overall mental and physical health than people who don’t. Meditation can reduce stress and anxiety, lower your blood pressure, improve your sleep, and boost your memory and concentration skills.

Dialectical behavior therapy helps patients learn true self-awareness. It gives them the tools to observe their behavior with a sense of detachment so they can understand how the decision they make can have a negative impact on their well-being as well as the feelings and emotional health of the people around them.

The end result is often an ability to better control their behavior and reactions. Once a patient knows that their reactions are hurting the people they love, they have an incentive to learn how to control those reactions and temper them accordingly.

#4: Dialectical Behavior Therapy Uses Role Playing to Teach New Behavior

Many people who struggle with addiction find that they have a difficult time relating to the other people in their lives. Drugs and alcohol are what they use as coping mechanisms to help manage emotions that feel uncontrollable.

The reason that many addicts relapse after going through a rehabilitation program is that they don’t learn how to handle the negative emotions and thoughts that drove them to addiction in the first place. Failure to come to grips with the underlying causes of addiction ensures that the addict won’t have the tools they need to cope when they come out of rehabilitation.

One way that dialectical behavior therapy helps patients learn to cope is by using role-playing. Role-playing involves the therapist – or occasionally, another patient in a group session – playing the role of a significant person in the patient’s life.

The goal of role-playing is to let the patient act out their typical behavior and then examine it to learn better ways of dealing with stressful situations.

For example, a patient who had an antagonistic relationship with her sister might role-play a typical interaction with a therapy group.

She perceives the sister’s attitude to be judgmental and harsh. Whenever she talks to her sister, she reacts defensively and angrily in response to the emotions that she projects onto her sister.

The process of role-playing the situation might help her see that the judgment is coming not from her sister, but from herself. Once she sees the situation clearly, she can work on the way she reacts to her sister to decrease her stress and improve the relationship.

In some cases, it might be instructive for somebody else to play the patient’s role and for the patient herself to take the role of her loved one. Either way, role-playing is an important part of dialectical behavior therapy.

#5: Dialectical Behavior Therapy Gets at the Heart of Addiction

The final thing you need to know about dialectical behavior therapy is that it gets at the root causes of addiction.

The problem with some rehabilitation programs is that they fail to examine the issues that drove a patient to addiction in the first place. Sobriety does not mean anything if the entire focus of rehabilitation is on avoiding the addictive behavior for the duration of the program.

Staying away from drugs and alcohol is only the tip of the iceberg when it comes to overcoming addiction and leading a sober, healthy life. If you come out of rehab not understanding why you started drinking or using drugs in the first place, you won’t have the tools you need to avoid relapsing at some point in the future.

Dialectical behavior therapy encourages patients to dig deep into their emotions and identify their triggers. They have to do the work to identify and understand their emotional reactions. They must examine their interpersonal relationships one at a time and work to improve them.

By combining intense talk therapy with activities like those listed below, patients slowly and surely come to understand what led them to addiction and what they can do to avoid a relapse.

  • Role playing with the patient playing himself as well as significant people in his life.
  • Mindfulness training to learn detachment and examine emotions without self-judgment.
  • Intense self-care that focuses on learning how to cope with negative emotions.
  • Identifying emotional triggers and coming up with ways to avoid and/or cope with them.

The process of going through dialectical behavior therapy can be a deeply profound and sometimes unsettling experience. Any time a person engages in self-harming behavior, whether it’s cutting, suicidal ideation, or drug and alcohol abuse, it is essential to understand what led to the harmful behavior.

Over time, dialectical behavior therapy can help patients get a deep understanding of their addictive behavior so that they can cope with it in the future.


The bottom line is that therapy is an important part of recovery for anybody who is struggling with addiction. One person may respond better to one kind of therapy than another, but there is no question that serious ongoing care is required if patients want to kick their addictions for good.

For patients who have struggled with extreme emotional reactions, dialectical behavior therapy may be the right choice on an ongoing basis. It combines individual and group therapy with the teaching of Buddhism to give patients the tools they need to live sober and healthy lives.